Is the NHS really over-managed?

 
Managers There are over 35,000 managers in the NHS in England

It has become fashionable to bash NHS managers.

In fact, it is a common joke within the profession that you are better off saying you are an estate agent than health manager.

It is easy to understand why.

Ministers have been quick to criticise the "pen-pushing culture" in the NHS with both current Health Secretary Jeremy Hunt and his predecessor Andrew Lansley promising to reduce bureaucracy in the NHS.

The number of managers in the health service has already been cut by nearly 7,000 in the last three years and now stands at 35,650 in England.

But in the rush to tackle the "problem" has it been properly considered whether management and leadership in the NHS actually needs sorting out?

Research to be published later this summer by the Chartered Management Institute shines an interesting light on the issue.

The work has found the NHS has a poor record in investing in its managers.

Compared to other parts of the public sector, it spends nearly 30% less on training its leaders, the research suggests.

The CMI goes on to argue that this is misguided as good management leads to an engaged workforce that is more productive and provides better care.

Ian Reynolds, the chairman of Kingston Hospital, who has been crunching the figures for the CMI, is clear.

"It may be unfashionable to say so, but overall the NHS is under-managed."

Dean Royles, director of NHS Employers, agrees managers have been unfairly targeted.

While acknowledging the failure in management over the Stafford Hospital scandal had been "deeply embarrassing", he also believes good managers are a force for good.

"We know if we have engaging managers we have an engaged workforce. These staff are more likely to be committed, work well as a team and go that extra mile for patients," he says.

 
Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this
    0

    Comment number 272.

    @James Allen, you could not be more wrong if you tried. How will your medical sciences degree qualify you to be a professional manager? There is an essential place in NHS management for experienced medical professionals, in partnership with professional managers and provided they are well-trained in management. But a wet-behind-the-ears graduate with "passion for medicine"? No thanks.

  • rate this
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    Comment number 271.

    @laughingman - with you right there, I am at the end of a medical sciences degree and wish to manage within the NHS, as I know that I could apply my interest in medicine (and my back ground in care) effectively within the NHS. I know that someone with a degree in management won't have the same passion for medicine, and as a result will be worse...

  • rate this
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    Comment number 270.

    Just what do many of the responders below fail to comprehend? The NHS has always been controlled (aka 'managed') by doctors and nurses, but they are expert in blending into the background when things go wrong (with care that they and only they are actually delivering). Doctors and nurses are only managed by their own...guess who investigates and exonerates?

  • rate this
    +1

    Comment number 269.

    Sometimes it's necessary to cut costs, meaning wages. Now who decides the redundancies? Managers. Whom do they make redundant? Nurses. They are not going to sack themselves yet the saving from sacking 10 nurses = the same as from sacking one manager. Fewer nurses = patients waiting sometimes hours in pain and discomfort. Fewer managers = fewer pie charts, tick boxes and meetings. Ask patients.

  • rate this
    +2

    Comment number 268.

    If the NHS seriously reckons it needs more managers, maybe the real issue is that too many of the current managers were almost certainly recruited from generic backgrounds with no prior experience of working in the NHS.

    Sadly, the issue of managers with little 'hands on' knowledge of the Industries they control seems all too common in the UK, as I am sure most people have experienced first hand.

  • rate this
    +1

    Comment number 267.

    My estimate would be 10% of the nursing staff I observed at close-hand were of a caring disposition; another 10% were case-hardened and capable of brutality and the rest saw it as just another job. The RCN (there's a laugh, a Royal College responsible for standards and and a TU combined!) could only be the result of another compromise to keep the "angels" happy. We mustn't upset them or...

  • rate this
    0

    Comment number 266.

    Most management sat in an office have no idea what frontline jobs involve.
    All they see is black and white, targets and budgets.

    Maybe if they worked a few days in the various departments, they would discover we do not have enough time to do the job as properly as we want. Yet alone meet the ridiculous targets they set us.

  • rate this
    0

    Comment number 265.

    @ 260/264. Q.Who is delivering actual care to real patients in the NHS?

    A. It is not the managers, but they are collectively dragged through the mud if anything like Stafford happens.

    A whole series of standard excuses...staffing levels too low, too many agency staff, poor environmental conditions etc are rolled-out. The simple truth is that management have no direct control over any "pro".

  • rate this
    +1

    Comment number 264.

    @260. Having worked alongside some of these ex-nurses/doctors in a managerial capacity you quickly learn never to contradict. Because of their former role, NHS Boards perhaps feel reassured by their presence in the managerial chain. The obverse is their tendency to cover-up any mistakes by their former professions (they still behave as active doctors or nurses years after becoming 'managers).

  • rate this
    +2

    Comment number 263.

    "Over-managed"?
    No.

    "Under-managed"?
    No.

    "Mismanaged".

  • rate this
    -1

    Comment number 262.

    Its the managers that are in control of the departments budgets. When labour poured in millions into the NHS it made little impact due to its incompetent use.
    Even now thousands upon thousands of pounds are bring wasted on hair brain schemes.
    My trust spent £10, 000 on a totally inadequate fence for its carpark and had to renew it costing more. The list could go on. As does the costs.

  • rate this
    +1

    Comment number 261.

    Re msg 260 - Could not agree more. RCN, BMA, GMC - they are not there to protect your interest, but the interest of their members, doctors, nurses, one & all. I attended a training session on Root Cause Analysis & one of the other attendee worked for the RAF, where after 24 yrs of service, you are turfed out, whereas as a nurse, doctor, you can go on even when you are not fit to practice!

  • rate this
    +2

    Comment number 260.

    Q. Who is behind the over managed mantra that the media reinforces?

    A. Doctors and nurses leaders who use the supposed pen-pushers to cover their inadequacies.

    Many key positions in the managerial chain are ex-doctors and nurses who are often of the 'I can't hack-it as a nurse, so I'll opt for management" types. The organisational influence of these key players far outweighs their numbers.

  • rate this
    +2

    Comment number 259.

    I have never worked for the NHS. But I do have to point out that over the last 10 years (probably before, I just wasnt aware of it), rules and regulations, targets and funding methods have been changed by MPs on an almost annual basis.

    How are managers meant to keep up if the requirements of the MPs change more quickly than new regimes can be put in place? MPs must share blame for the waste.

  • rate this
    +2

    Comment number 258.

    The existence of the outdated post of manager is a real problem. Current managers have often been responsible for bullying and sexual harassment. Many don’t understand the specialist areas they manage, or HR best practice. Management qualifications seem to be “ambitious” and “willing to be ruthless”. Their salaries reflect their use as an unquestioning weapon or owners/boardrooms.

  • rate this
    +1

    Comment number 257.

    We now have not 1 but 2 audits related to PbR abandoned, because the new IT system has been purchased to get the data; managers have little or no integrity, will lie or omit to tell you the truth, to get their own way; is this an organisation I want to continue to work for, yes, in the main, because I enjoy the job I do, but do have issues regarding complete waste of resources!

  • rate this
    +1

    Comment number 256.

    NHS Managers are really committed and really overworked - they often do not feel they have time to give to learning and development. Plus there is a culture of using highly expensive consultants to advise (ref Monitor) when there are some excellent and more cost effective freelancers/smaller firms.

  • rate this
    +1

    Comment number 255.

    I objected to a manager using clinical audit facility to getdata for PbR, but my director & manager over ruled my decision; we spent huge amount of resources (approx 5000 forms were printed), all midwives in hospital as well as the community were to complete the forms (as if they did not have any paperwork already) & within 2 months of these resources being wasted, the manager had joined a CCG!

  • rate this
    +1

    Comment number 254.

    When I worked for the NHS, medics with no commercial or management training ruled the roost. They were even heard to say 'I won't prescribe non-branded drugs as I have shares in big pharma'. They took expensive hospitality from the same firms. Medics are often great at their jobs, but let's not pretend they can do commercial managers' jobs. They need to learn what 'conflict of interest means'.

  • rate this
    0

    Comment number 253.

    What annoyed me most about NHS managers was when the agenda for change came in.
    The managers went into a scrum taking jobs on below their roles to justify their banding so they didn't lose out.
    I never had the opportunity to do that. Abuse of position really.

 

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